Wisconsin

Based on more complaints, Wisconsin legislators demand audit of MTM

Based on complaints from BadgerCare and Medicaid recipients about no-show medical rides, late cancellations and inappropriately equipped vehicles scheduled with MTM Inc., Wisconsin legislators are again demanding an audit of the transportation program.

Legislators are concerned that MTM is driving small transportation providers out of business and making it more difficult for patients to get rides to medical appointments, especially in rural areas.

The legislators want the audit to address the number of complaints, the complaint process, the process for scheduling rides and determining which provider is selected, oversight actions by the state Department of Health Services and the financial effect of the program on taxpayers, according to the letter.

MTM has been dispatching medical rides for seniors and poor residents who have no other way to get to Medicaid-covered services since August. MTM hires other companies to provide the rides. The company took over from LogistiCare, which experienced similar problems when it ran the service. The Milwaukee Journal Sentinel chronicled those in a series of stories.

Veteran transportation providers say MTM is trying to force them to cut their mileage rates by 15% to 20%, making rides not financially viable. They contend MTM does so by drastically reducing the number of rides providers get assigned and offering providers more rides only if they cut their rates by 15% to 30%. Meanwhile, providers say, MTM uses cheaper but less reliable companies who often leave patients without a ride to or from their appointments.

Long-term transit providers said that, as a result of fewer rides, they've been forced to cut employees, reducing the number of drivers available. That means when problematic, less reputable providers turn down a ride at the last minute, there's no backup.

As the Milwaukee Journal Sentinel reported Jan. 28, BadgerCare and Medicaid recipients from around the state say they've been stood up by no-show rides provided by MTM's subcontracted companies. Some patients' rides were rescheduled with the same provider that repeatedly failed to show. Other patients say their appointments were canceled last minute without notice.

Lynnae Zahringer, supervisor of long-term support unit at Shawano County, said some patients are now so fed up that they have given up on scheduling rides and avoid going to their doctor's appointments entirely.

She said an 84-year-old woman was stood up for a ride to a medical appointment. As a result, her eye surgery had to be delayed. A 62-year-old woman with cerebral palsy who can't move without assistance was not allowed to have her friend who assists her to appointments ride along with her. On one of her rides, the driver polished her nails while driving. On another, the driver smoked in the car. The patient has asthma and asked him to stop.

"He rolls down his window. Really? Come on. These people, they're individuals who have health issues and we just need to be cognizant of that and be respectful of that," Zahringer said.

She said MTM is sometimes unable to find a contracted provider with a wheelchair-accessible vehicle, but a non-contracted company can't always provide a ride on late notice.

"My biggest frustration is, we're dealing with clients and customers that need to have the service, who are caught in the middle," she said.

By contrast, Julie Dixon-Seidl of Milwaukee-based Disability Rights Wisconsin said she has seen a drastic reduction in complaints about no-show rides, late rides and pickups since MTM started. Most complaints are from patients who have been asked to take the bus and want to be exempted.

Michele Lucas, a spokeswoman for MTM, said the company's latest data doesn't suggest an increase in complaints, either.

"The preliminary data does not suggest a negative trend in canceled rides or no-show rides," she said in an email.

The letter said in part, "Complaints are not adequately acted upon. It is also unclear that the Department of Health Services is appropriately assessing fiscal damages for the poor service our constituents have received."

Under MTM's contract, the DHS can assess damages of up to $1,000 for repeated late and no-show rides, but it hasn't assessed any penalties so far. It is, however, working with MTM to address problems apparent from data for MTM's first two months in Wisconsin, August and September 2013, DHS spokeswoman Claire Smith said.

"After reviewing the first two months of finalized data, the state began working with MTM to create and carry out a Corrective Action Plan for improvement," Smith said in an email. "If the transportation providers and their drivers do not meet the set standards of service, MTM will work through a performance improvement plan and, if necessary, stop utilizing the driver (and possibly the provider) to provide rides to Medicaid and BadgerCare Plus members."

She encouraged members to file complaints with MTM if drivers do things such as text while driving or are late. She said the state reviews summaries of all complaints MTM receives as well as resolutions to ensure all complaints are handled in accordance with policy. Smith did not specify what concerns were raised in the improvement plan, what solutions are being pursued or whether there's a deadline.

The state has refused to get involved in trip volume and reimbursement rates, saying it's a private contractual issue between MTM and the providers.

Medicaid rules don't set a minimum amount of reimbursement that states must provide. However, states are required to make sure there's enough transportation to provide "adequate access" to Medicaid-covered services.

Jim Morgan, a sales manager at Durable Contract Services Inc. in Milwaukee, said his company used to provide 100 rides per day under LogistiCare but now gets about 10. As a result, he has laid off three employees and is down to 47. His company used to receive $10 for the first five miles for the cheapest rides under LogistiCare. It currently gets $14.50, but in December an MTM manager sent his company an email offering "Trip volume increase options:" Expand your service area or "restructure" your rates to $10 — a 31% cut.

"I can't operate on 10 rides," Morgan said, but "there's no guarantee if you lower your rates, you'll get more rides."

Mazen Rezk of City Wide Transit Inc. in Milwaukee said costs of providing transportation are rising — from insurance and gasoline to MTM-required training and health testing. Transportation providers have not received a raise since 1993, when gas was less than $1.20 per gallon, he said. At the current gas prices, some drivers make less than $50 a day, he said. Rezk said he has laid off five of 20 employees to reduce costs.

"We're at a breaking point," he said. "The foundation of the program is deteriorating at a faster rate than you can ever get another provider. We're willing to stay for the long haul, but I need respect. I cannot do it at the expense of my livelihood."

The legislators pointed out that MTM has a financial incentive to provide as little service as possible because the company gets paid a fixed amount regardless of the services it provides.

"While we should welcome innovation and efficiency, we must provide a reasonable baseline of service to the people who rely on this program. We are currently paying higher costs for less reliable services," the letter says. "Perhaps there is another model the state could pursue that could be more cost-effective and provide better service to these citizens."

Eric Koch, speaking for Schaber's office, said a bad relationship between MTM and providers could ultimately make it more difficult for patients to get rides and affect other areas because transit companies also contract with counties, cities, school districts and other entities.

"So if we lose these providers, it's very concerning, especially in rural areas where there may only be one provider," he said. "As we see the deterioration of the infrastructure with the rides, it's not going to get any easier for the people who need the rides. The two really do go hand in hand."

It's the third time legislators have called for an audit. The previous two attempts were unsuccessful because other audits took priority.